Aim of study
Our aims are to assess if Gastrus administration:
reduces the incidence of SIBO;
reduces the risk of infections in children treated with gastric-acid inhibitors;
prevents perturbation of gut microbiota and related dysbiosis;
Study Product Gastrus sachets/chewable caps: 2x108 CFU Lactobacillus reuteri DSM 17938 +
2x108 CFU Lactobacillus reuteri ATCC PTA 6475.
Placebo sachets/chewable caps: Identical in shape, colour and taste to Gastrus capsules
but without the Lactobacillus reuteri components.
Both study products are delivered in identical containers. Dosing: Two sachets/cps twice
a day. Length of treatment: Gastrus or placebo will be administered for all the duration
of PPI administration (8 weeks) plus two weeks after its discontinuation. A final
evaluation will be performed 4 weeks after the discontinuation of both Gastrus and
placebo.
Compliance, PP and ITT To be considered compliant the participant should have consumed at
leas 80% of the doses. In order to improve compliance, the participants will be equipped
with alarm-devices. Compliant patients will be assessed as Per-Protocol (PP). Patients
that are non-compliant will be included in the Intention-To-Treat analysis.
Outcomes Primary efficacy parameter This study aimed at investigating if Gastrus
administration prevents the emergence of SIBO and reduces the risk of infections in
children treated with proton pump inhibitors and.
Exploratory parameters Ability of Gastrus to prevent and control gut microbiota
alteration; Ability of Gastrus to improve GI symptoms for which the drug has been
prescribed.
Sample size calculation Assuming that the average rate of infection in patient who assume
PPI is 32% as compared to 9% of those who do not use the drug (16), to demonstrate an
efficacy of the probiotic, keeping a power of the study of 80% and a p of 0,05 we need 78
patients for group that, considering a drop out of 10%, will became 86 per group (patient
younger/older 4 years of age:0,75) This sample size is by far larger than needed to
demonstrate the preventive effect on SIBO emergence.